The objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives of robotic laparoendoscopic single-site surgery (R-LESS). A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). All clinical and investigative reports for robotic LESS and NOTES procedures in the urological literature have been considered. A significant number of clinical urological procedures have been successfully completed utilizing R-LESS procedures. The available experience is limited to referral centers, where the case volume is sufficient to help overcome the challenges and learning curve of LESS surgery. The robotic interface remains the best fit for LESS procedures but its mode of use continues to evolve in attempts to improve surgical technique. We stand today at the dawn of R-LESS surgery, but this approach may well become the standard of care in the near future. Further technological development is needed to allow widespread adoption of the technique.

Abstract We performed bilateral robotic single-site partial nephrectomy on a 51-year-old man with bilateral renal tumors. Left partial nephrectomy without renal arterial clamping and right partial nephrectomy with a warm ischemic time of 29 minutes were performed through a single umbilical port and one additional port. The total operative time was 350 minutes including 238 minutes of robotic console time. There were no operative complications and no open conversions. Follow-up exams over a 12-month period showed no tumor recurrence. Our report shows the technical feasibility of bilateral robotic single-site partial nephrectomy.

“Laparoendoscopic single site (LESS) radical prostatectomy:a review of the initial experience.”

Silberstein, J., N. Power, et al. (2011).

Minerva Urologica e Nefrologica 63(2): 123-129.

Surgical treatment for prostate cancer has changed dramatically in recent years due to the incorporation of minimally invasive techniques in the surgical armamentarium. Open surgical approaches to the prostate have largely given way to laparoscopic and robotic techniques. In order to further reduce incisional morbidity and improve cosmesis, there has been a recent interest in laparoendoscopic single site (LESS) approaches to the prostate. Despite a rising interest, there is little available data on these procedures. We performed a systematic review of the literature using MEDLINE, OVID, and Web of Science to identify all publications including LESS radical prostatectomy to date. Manual bibliographic review of cross-referenced items was also performed. We attempt to identify and summarize existing data on these procedures both with and without robotic assistance. Additionally, we review the emerging devices, instruments, cameras, and ports that have made these procedures possible. Next, we offer insight into how this rapidly moving field may transition in the future. Finally, we provide our commentary on this surgical approach, its impact on urology, and how it may help us evolve in the future.

Academic Journal of Second Military Medical University 32(4): 409-412.

Objective To make an initial attempt to use robotic single-site surgery for laparoscopic partial nephrectomy and ureteropelvic angioplasty in pigs, so as to assess the feasibility and ergonomics of the robotic single-site surgery in laparoscopic urological reconstruction surgery and to summarize the manipulation experience. Methods Partial nephrectomy: at a lateral position, a 4 cm incision was made at the level of hilum on the lateral border of the rectus muscle, and the subcutaneous tissue layer was dissected bluntly with the Kelly clamp. After pneumoperitoneum was established by the veress needle, four trocars were introduced in the shape of diamond, including two 8 mm robotic trocars on the left and right rides and two 10 mm surgiquest trocars on the upper and lower rides. After the robotic tower was docked, the procedure of nephrectomy was performed routinely. And the renal defect was closed by a horizontal mattress suture with “sliding-clip technique”. Pyeloplasty: all trocars were removed and a 4 cm long incision was made; the novel suriquest robotic port was introduced into the abdominal cavity. Two 8 mm robotic metal trocars were introduced from two sides of the surgiquest port in the way of “1 + 1″. After the robotic arm was docked, the pyeloplasty was performed. Results Partial nephrectomy were successfully performed in two cases, with the time for establishing access bring 5 min and 8 min, time for docking the robotic system bring 11 min and 9 min, time for operation bring 55 min and 42 min, and time of warm ischemia bring 23 min and 18 min, and with the blood loss bring 50 ml and 20 ml. Pyeloplasty were successfully performed in two cases, with the time for establishing access bring 17 min and 12 min, time for docking the robotic system bring 5 min and 4 min, and time of operation bring 32 min and 25 min, andwith no blood loss. Conclusion After proper setup of trocars, the roboic single-site operation under laparoscope can complete the complex urological reconstructive surgery. And the novel surgiquest port can obtain more ideal ergonomics outcomes.